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Anti-VEGF Toxicity — SCE Medical Oncology MCQ

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ModerateImmunotherapy & Targeted TherapyAnti-VEGF ToxicitySCE Medical Oncology

A 65-year-old man on lenvatinib + pembrolizumab for advanced renal cell carcinoma develops a 2 cm wound dehiscence 3 weeks after an elective hernia repair. He was told to stop lenvatinib perioperatively but restarted it 5 days post-surgery. What is the underlying mechanism?

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Correct answer: C — Anti-VEGF effects of lenvatinib impairing wound healing

VEGFR-TKIs (lenvatinib, sunitinib, cabozantinib) and anti-VEGF antibodies (bevacizumab) impair wound healing by inhibiting angiogenesis required for tissue repair. Standard practice is to hold anti-VEGF agents for at least 2-4 weeks before elective surgery and until adequate wound healing post-operatively (typically 4+ weeks). Premature restart (5 days) directly contributed to the wound dehiscence. This is a class effect of all anti-VEGF therapies.

Reference: BNF Lenvatinib monograph; ESMO 2024 Supportive Care Guidelines